Appellate Updates

Shalghoun v. North Los Angeles County Regional Center, Inc. (Jan. 25, 2024, B323186) __ Cal.App.5th __ [2024 WL 277313]

Under the Lanterman Developmental Disabilities Services Act (Welf. & Inst. Code, § 4500 et seq.), California uses a network of private, nonprofit entities called “regional centers” to provide developmentally disabled persons with individually tailored services and support. The North Los Angeles County Regional Center placed J.C., a developmentally disabled adult, in a licensed adult residential facility. Ali Shalghoun, the facility’s administrator, asked the Regional Center to relocate J.C. after he repeatedly exhibited aggressive behavior. While the Regional Center was seeking to place J.C. in another facility, he attacked and seriously injured Shalghoun. Shalghoun sued the Regional Center for negligently failing to prevent the attack. The trial court granted the Regional Center’s motion for summary judgment on the ground that the Regional Center owed Shalghoun no duty of care. Shalghoun appealed.

South Coast Specialty Surgery Ctr. v. Blue Cross of Cal., __ F.4th __, 2024 WL 105317 (9th Cir. Jan. 10, 2024)

South Coast Specialty Surgery Center sought reimbursement from Blue Cross of California (Anthem) for the costs of medical services provided to patients (plan participants) who had executed assignments to South Coast of their insurance benefits. After Anthem implemented a “pre-payment review” process that limited coverage for South Coast’s services, South Coast sued Anthem under ERISA to recover $5.4 million in unpaid services. 

Yalung v. State (Dec. 21, 2023, F084367) __ Cal.App.5th __ [2023 WL 8821363]

Sara Spagnolini worked as an In-Home Supportive Services (IHSS) provider running errands for an IHSS recipient. She ran a stop sign and crashed into Hanah Yalung’s vehicle, killing one of Yalung’s children and seriously injuring Yalung and four other children. Yalung sued the State of California, alleging it was vicariously liable for Spagnolini’s negligence, either as her employer or as a joint employer with the IHSS recipient because it paid her salary. 

Baglione v. Health Net of California, Inc. (Nov. 27, 2023, B319659) __ Cal.5th __ [2023 WL 8446102]

Salvatore Baglione obtained his medical insurance through his employer, the County of Santa Clara, which contracted with insurance provider Health Net. Baglione signed an enrollment form for Health Net, as well as a group contract between the County and Health Net. A few months later, Baglione was diagnosed with a chronic condition requiring a monthly injectable medication.

Gutierrez v. Tostado (Dec. 1, 2023, H049983) __ Cal.App.5th __ [2023 WL 8296004]

Francisco Gutierrez was rear-ended by an ambulance driven by Uriel Tostado—an emergency medical technician—who was transporting a patient between medical facilities.

Saloojas, Inc. v. Aetna Health of Cal., Inc., 80 F.4th 1011 (9th Cir. 2023)

Saloojas, Inc. provides COVID-19 diagnostic testing at a list price published on its website.  Aetna is a health insurer that provides COVID-19 tests to its insureds under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. 

Long Beach Memorial Medical Center v. Allstate Ins. Co. (Sept. 19, 2023, B321876) __ Cal.App.5th __ [2023 WL 6115891]

Long Beach Memorial Medical Center (Medical Center) treated Vernon Barnes for injuries he suffered in a car accident.  Barnes submitted a personal injury claim to Allstate, which insured the driver who Barnes claimed was at fault for the accident.

Raines v. U.S. Healthworks Medical Group (Aug. 21, 2023, S273630) __ Cal.5th __ [2023 WL 4697232 ]

Kristina Raines was offered employment contingent upon a medical screening by U.S. Healthworks Medical Group (USHW), an agent of her future employer. After she responded to all but one question on an extensive health history questionnaire, USHW terminated the exam.

Rhonda S. v. Kaiser Foundation Health Plan (July 28, 2023, B318650) __ Cal.App.5th __ [2023 WL 5318406], ordered published Aug. 18, 2023

Rhonda S. was appointed as the conservator of her adult son (David, who suffers from schizophrenia) under the Lanterman-Petris-Short Act (LPS; Welf. & Inst. Code, § 5350).

Moran v. Prime Healthcare Management, Inc. (Aug. 7, 2023, G060920) __ Cal.App.5th __, 2023 WL 5012110

Gene Moran received emergency care at a Prime Healthcare hospital and was charged an emergency room evaluation and management services (EMS) fee in addition to the charges for treatment provided.